Concepts for improved regioselective placement of O-sulfo, N-sulfo, N-acetyl, and N-carboxymethyl groups in chitosan derivatives.

In the present paper a new strategy has been studied to introduce solely or in combination N-sulfo, O-sulfo, N-acetyl, and N-carboxymethyl groups into chitosan with highest possible regioselectivity and completeness and defined distribution along the polymer chain. The aim was to generate compounds having lowest toxicity for determining the pharmacological structure function relationships among different backbone structures and differently arranged functional groups compared to those of heparin and heparan sulfate. The water-soluble starting material, chitosan, with a degree of acetylation (DA) of 0.14 and a molecular weight of 29 kD, allows one to apply most of the known reactions of chitosan as well as some reactions of heparin chemistry successfully and with improved regioselectivity and completeness. On the other hand, a number of these reactions were not successful by application to water-soluble high-molecular-weight chitosan (DA 0.45 and 150 kD). The starting material showed statistical N-acetyl (N-Ac) distribution along the polymer chain according to the rules of Bernoulli, with highest abundance of the GlcNAc-GlcNAc diad along with a lower abundance of triads, tetrads, and pentads. The space between the N-Ac groups was filled up in homogeneous reactions by N-sulfo and/or N-carboxymethyl groups, which also resulted in a Bernoulli statistical distribution. The N-substitution reaction showed highest regioselectivity and completeness with up to three combined different functional groups. The regioselectivity of the 3-O-sulfo groups was improved by regioselective 6-desulfation of nearly completely sulfated 3,6-di-O-sulfochitosan. By means of desulfation reactions, all of the possible intermediate sulfated products are possible. 6-O-Sulfo groups can also be introduced with highest regioselectivity and completeness, and a number of partially 6-desulfated products are possible.

[Approaches to self-help of anxiety disorders without drugs]. / Nichtmedikamentöse Ansätze zur Selbsthilfe von Angststörungen.

Self-help is recommended for moderate variations of the mental state, i.e., anxiety equivalents, anxious reactions to excessive demands, constitutional anxiety, or justified but long lasting concerns. Additionally, these are also accessible by a specific psychotherapy or pharmacological anxiety treatment. In particular, these are physical activities for a supportive anxiolysis, physical therapy, relaxation exercises, and therapeutical self-conversation which can be seen as a mental hygienic measure helping towards relieving expressions and to see the trigger situation in relative terms. A more and more important role in coping with physical and mental diseases is the participation in self-helping groups. The validation and selection of such a group should be undertaken in consultation with the physician in charge and the family physician, respectively. All drugless approaches for the self-treatment have their special value in increasing one's own initiative.

[The depressive syndrome]. / Das depressive Syndrom.

Depression is not like depression. For that it is important to divide the various impairs of emotional life: mood fluctuations--sorrow reactions--depressions. This provides specific knowledge about the versatile and so often misleading depressive syndrome--and not only at the doctors, but also at the concerned and especially the relatives, even friends, colleagues, neighbours and so on. Only this way it is possible to shorten the, within tormenting, time between the beginning of the depression and the first consultation of a doctor.

[Adult children of alcoholics. A new diagnostic group with reference to general practice and clinical aspects]. / Erwachsene Kinder von Alkoholikern. Eine neue diagnostische Gruppe mit Relevanz für Praxis und Klinik.

UNLABELLED: FUNDAMENTAL CONSIDERATIONS: Adult children of alcoholics have, in recent years, become identified as a specific group with often characteristic patterns of health disorders. MAJOR POINTS: Those involved have a three- to four-fold greater risk of developing a dependence themselves than the general population. They are more likely to marry partners who are also dependent and have an above-average propensity toward separation and divorce. Most members of this group have adopted a specific role within the family they come from: for example that of the whipping boy, family hero or fool. Of therapeutic importance is the recognition of one's own involvement through parent dependence and to develop an awareness of specific areas of disorder, for example, in a partnership, self-identity crises, emotional blockades and the risk of becoming dependent oneself. CONCLUSIONS: Therapists with experience of habit-forming disorders and social family work can develop specific activities within the general practice, psychosocial counseling centers, and even in detoxication services. The new self-help groups of adult children of alcoholics are very helpful.

[Suicide in the Ravensburg/Oberschwaben area. Results of a study of 508 suicides based on criminal police records]. / Suizide im Raum Ravensburg/Oberschwaben. Ergebnisse einer Untersuchung von 508 Suiziden anhand kriminalpolizeilicher Unterlagen.

On the basis of criminal police files we studied 508 suicides which happened between 1970 up to 1981 in the Ravensburg area in southern Germany. The police files also included medical records about in- or outpatient psychiatric treatment and also data about former violent behaviour. Mental disease as follows were most frequent: Depression 66% (diagnoses were made according to IDC-0 by two doctors under supervision of two senior psychiatrists; ICD-9: 300.4, 309.0 and 309.1 22%, ICD-9 296.1, 296.3 7.1% of the entire suicide group); neuroses and personality disorders 19%, addition, especially alcoholism, 28%. No psychiatric diagnosis could be made retrospectively in 10.6% (54 suicides). Sign in the presuicidal development like depressive symptoms, hopelessness and feelings of having no future, sleeping disturbances, feelings of guilt and anxiety, inner restlessness, but also changes in the direction of serenity and relaxation, treats of suicidal behaviour and reactions of the family and environment were reported showing a broad span of reactions from lack of perception to wrong interpretation. 15% of the suicides had also criminal activities in their former history. From a psychiatric point of view, improved diagnostic and therapeutic procedures in the treatment of the mentally ill, especially in the field of outpatient medical care of depressive and addictive patients, and better information of the relatives is to be demanded in order to prevent suicides.

[Diagnosis of mania. Disease picture and its psychological, physical and social sequelae]. / Zur Diagnose der Manie. Das Krankheitsbild und seine seelischen, körperlichen und gesellschaftlichen Folgen.

While depression is a commonly discussed condition, mania is rarely mentioned. Subjectively, this disorder is associated with less incapacitating complaints, but it may have a more troublesome effect on the patient and the people around him than most mental illnesses. This article therefore presents a practice-oriented overview of the manic syndrome and its consequences: the term, its definition, age and sex distribution, mental and physical symptoms, psychosocial consequences, aspects of differential diagnosis, information for relatives and the family doctor, aspects of criminal and civil law, are discussed.

[The reaction of mental patients to medical diagnosis]. / Die Reaktion des psychisch Kranken auf die ärztliche Diagnose.

According to the results of a social psychiatric research on hand of reflected image transformulated questionnaire for clinical healthy persons and hospitalized patients the following result is: 9/10 of all registered laymen are afraid of dramatic scenes (manifold naming). In each second case such a situation however happens obviously extensive deactivated. More than five times of the shocked persons as healthy respondents refuse at these questions a comment. But in laymen circles they believe double till three times so frequently in sadness and desperation respectively revolted rebel of the patients. In reality you can find very often the still resignation or the facilitated acceptance of the necessary steps. The more simple the origin class the more exists resignation or cooperation. In reverse rebel, depressive reaction and desperation again continuously on relevance due to the medicine diagnosis from the primary to the upper class. Depressives react sadly and desperatedly as well as female maniacs. People who are free from alcohol will have found the expected silence. The schizophrenes as well as the male maniacs seem to rebel revolted.